Provider Demographics
NPI:1245249739
Name:PHALEN, DIANE MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:PHALEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1305 WONDER WORLD DR STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7542
Mailing Address - Country:US
Mailing Address - Phone:512-396-0808
Mailing Address - Fax:512-396-0804
Practice Address - Street 1:1305 WONDER WORLD DR STE 304
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7542
Practice Address - Country:US
Practice Address - Phone:512-396-0808
Practice Address - Fax:512-396-0804
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0992213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15276Medicare UPIN
TX00DC53Medicare PIN